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Older-Generation Antihistamines and Cough Due to Upper Airway Cough Syndrome (UACS): Efficacy and Mechanism

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Abstract

Older-generation H1 antihistamines are recommended in empiric protocols for the treatment of cough due to upper airway cough syndrome (UACS). Data from double-blind placebo-controlled trials that support the use of older-generation antihistamines in UACS are limited to a single study of cough due to the common cold. However, several empiric trials strongly support efficacy of older-generation antihistamines in patients with chronic cough. Data from a variety of studies support the concept that newer-generation H1 antihistamines are not useful in the treatment of cough due to UACS. The mechanism of action of older-generation H1 antihistamines has been proposed to be anticholinergic activity, but the rank order potency of these drugs as muscarinic receptor antagonists is not consistent with this hypothesis. Actions of these drugs on histamine H1 and/or nonhistaminergic receptors in the central nervous system remain a possible explanation for their effects on cough due to UACS. The effects of older H1 antihistamines may also be molecule specific, rather than attributable to the entire class of compounds. Additional studies should be performed to document the activity of these drugs in double-blind placebo-controlled trials.

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References

  1. Pratter MR (2006) Chronic upper airway cough syndrome secondary to rhinosinus diseases (previously referred to as postnasal drip syndrome): ACCP evidence-based clinical practice guidelines. Chest 129(1 Suppl):63S–71S

    Article  PubMed  Google Scholar 

  2. Pratter MR (2006) Cough and the common cold: ACCP evidence-based clinical practice guidelines. Chest 129(1 Suppl):72S–74S

    Article  PubMed  Google Scholar 

  3. Pratter MR (2006) Overview of common causes of chronic cough: ACCP evidence-based clinical practice guidelines. Chest 129(1 Suppl):59S–62S

    Article  PubMed  Google Scholar 

  4. Irwin RS, Pratter MR, Holland PS, Corwin RW, Hughes JP (1984) Postnasal drip causes cough and is associated with reversible upper airway obstruction. Chest 85(3):346–352

    Article  PubMed  CAS  Google Scholar 

  5. O’Connell F, Thomas VE, Studham JM, Pride NB, Fuller RW (1996) Capsaicin cough sensitivity increases during upper respiratory infection. Respir Med 90(5):279–286

    Article  PubMed  CAS  Google Scholar 

  6. Bolser DC (2006) Cough suppressant and pharmacologic protussive therapy: ACCP evidence-based clinical practice guidelines. Chest 129(1 Suppl):238S–249S

    Article  PubMed  CAS  Google Scholar 

  7. Muether PS, Gwaltney JM Jr (2001) Variant effect of first- and second-generation antihistamines as clues to their mechanism of action on the sneeze reflex in the common cold. Clin Infect Dis 33(9):1483–1488

    Article  PubMed  CAS  Google Scholar 

  8. Curley FJ, Irwin RS, Pratter MR, Stivers DH, Doern GV, Vernaglia PA, Larkin AB, Baker SP (1988) Cough and the common cold. Am Rev Respir Dis 138(2):305–311

    PubMed  CAS  Google Scholar 

  9. Parvez L, Vaidya M, Sakhardande A, Subburaj S, Rajagopalan TG (1996) Evaluation of antitussive agents in man. Pulm Pharmacol 9(5–6):299–308

    Article  PubMed  CAS  Google Scholar 

  10. Poe RH, Harder RV, Israel RH, Kallay MC (1989) Chronic persistent cough. Experience in diagnosis and outcome using an anatomic diagnostic protocol. Chest 95(4):723–728

    Article  PubMed  CAS  Google Scholar 

  11. McGarvey LP, Heaney LG, Lawson JT, Johnston BT, Scally CM, Ennis M, Shepherd DR, MacMahon J (1998) Evaluation and outcome of patients with chronic non-productive cough using a comprehensive diagnostic protocol. Thorax 53(9):738–743

    Article  PubMed  CAS  Google Scholar 

  12. Morice AH, Fontana GA, Sovijarvi AR, Pistolesi M, Chung KF, Widdicombe J, O’Connell F, Geppetti P, Gronke L, De Jongste J, Belvisi M, Dicpinigaitis P, Fischer A, McGarvey L, Fokkens WJ, Kastelik J (2004) The diagnosis and management of chronic cough. Eur Respir J 24(3):481–492

    Article  PubMed  CAS  Google Scholar 

  13. Irwin RS, Corrao WM, Pratter MR (1981) Chronic persistent cough in the adult: the spectrum and frequency of causes and successful outcome of specific therapy. Am Rev Respir Dis 123(4 Pt 1):413–417

    PubMed  CAS  Google Scholar 

  14. Irwin RS, Curley FJ, French CL (1990) Chronic cough. The spectrum and frequency of causes, key components of the diagnostic evaluation, and outcome of specific therapy. Am Rev Respir Dis 141(3):640–647

    PubMed  CAS  Google Scholar 

  15. Pratter MR, Bartter T, Akers S, DuBois J (1993) An algorithmic approach to chronic cough. Ann Intern Med 119(10):977–983

    PubMed  CAS  Google Scholar 

  16. Mello CJ, Irwin RS, Curley FJ (1996) Predictive values of the character, timing, and complications of chronic cough in diagnosing its cause. Arch Intern Med 156(9):997–1003

    Article  PubMed  CAS  Google Scholar 

  17. Brightling CE, Ward R, Goh KL, Wardlaw AJ, Pavord ID (1999) Eosinophilic bronchitis is an important cause of chronic cough. Am J Respir Crit Care Med 160(2):406–410

    PubMed  CAS  Google Scholar 

  18. Dicpinigaitis PV, Gayle YE (2003) Effect of the second-generation antihistamine, fexofenadine, on cough reflex sensitivity and pulmonary function. Br J Clin Pharmacol 56(5):501–504

    Article  PubMed  CAS  Google Scholar 

  19. Berkowitz RB, Connell JT, Dietz AJ, Greenstein SM, Tinkelman DG (1989) The effectiveness of the nonsedating antihistamine loratadine plus pseudoephedrine in the symptomatic management of the common cold. Ann Allergy 63(4):336–339

    PubMed  CAS  Google Scholar 

  20. Berkowitz RB, Tinkelman DG (1991) Evaluation of oral terfenadine for treatment of the common cold. Ann Allergy 67(6):593–597

    PubMed  CAS  Google Scholar 

  21. Studham J, Fuller RW (1992) The effect of oral terfenadine on the sensitivity of the cough reflex in normal volunteers. Pulm Pharmacol 5(1):51–52

    Article  PubMed  CAS  Google Scholar 

  22. Gaffey MJ, Kaiser DL, Hayden FG (1988) Ineffectiveness of oral terfenadine in natural colds: evidence against histamine as a mediator of common cold symptoms. Pediatr Infect Dis J 7(3):223–228

    Article  PubMed  CAS  Google Scholar 

  23. Orzechowski RF, Currie DS, Valancius CA (2005) Comparative anticholinergic activities of 10 histamine H1 receptor antagonists in two functional models. Eur J Pharmacol 506(3):257–264

    Article  PubMed  CAS  Google Scholar 

  24. Montoro J, Sastre J, Bartra J, del Cuvillo A, Davila I, Jauregui I, Mullol J, Valero AL (2006) Effect of H1 antihistamines upon the central nervous system. J Investig Allergol Clin Immunol 16(Suppl 1):24–28

    PubMed  Google Scholar 

  25. Lilienfield LS, Rose JC, Princiotto JV (1976) Antitussive activity of diphenhydramine in chronic cough. Clin Pharmacol Ther 19(4):421–425

    PubMed  CAS  Google Scholar 

  26. Gray NM, Contreras PC, Allen SE, Taylor DP (1990) H1 antihistamines interact with central sigma receptors. Life Sci 47(2):175–180

    Article  PubMed  CAS  Google Scholar 

  27. Widdicombe JG (2003) Overview of neural pathways in allergy and asthma. Pulm Pharmacol Ther 16(1):23–30

    Article  PubMed  CAS  Google Scholar 

  28. Haxhiu MA, Van Lunteren E, Cherniack NS (1991) Influence of ventrolateral surface of medulla on tracheal gland secretion. J Appl Physiol 71(5):1663–1668

    PubMed  CAS  Google Scholar 

  29. McLeod RL, Mingo G, O’Reilly S, Ruck LA, Bolser DC, Hey JA (1998) Antitussive action of antihistamines is independent of sedative and ventilation activity in the guinea pig. Pharmacology 57(2):57–64

    Article  PubMed  CAS  Google Scholar 

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  1. Department of Physiological Sciences, University of Florida, P.O. Box 100144, Gainesville, Florida, 32610-0144, USA

    Donald C. Bolser

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  1. Donald C. Bolser
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Correspondence to Donald C. Bolser.

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Bolser, D.C. Older-Generation Antihistamines and Cough Due to Upper Airway Cough Syndrome (UACS): Efficacy and Mechanism. Lung 186 (Suppl 1), 74–77 (2008). https://doi.org/10.1007/s00408-007-9033-y

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  • DOI: https://doi.org/10.1007/s00408-007-9033-y

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